Nutritional Rehabilitation Protocol (NRP): Behavioral Health Home Hospitalization Plan

It is important that the guidelines outlined below are followed closely for children on the Home Hospitalization Plan. 

Meal Guidelines:

  • Caregivers are responsible for grocery shopping, menu planning, preparing all meals and snacks, and supervising all meals and snacks. Diet food, caffeine and chewing gum are not allowed.

  • Your child or teen is responsible for completing 100% of meals, snacks, and supplements (if needed). They cannot use weight scales – these should be removed or hidden. They cannot have access to websites, tv shows, movies or social media focused on food, cooking, weight, or shape.

  • Follow the time allowed for each eating period:

    • Meals: 30 minutes

    • Snacks: 15 minutes

    • Supplement: 15 minutes

  • Physical rest is required following eating. Your child cannot use the bathroom during the rest period unless directly supervised.

    • Meals: 1 hour rest period

    • Snacks: 30 minute rest period

Physical Activity Guidelines:

  • Only light activity within the home is permitted.

  • No exercise or sports activity is permitted.

  • Your child should remain in the common living area during the day.

  • Bedroom is for sleeping only.

  • Bathroom should be used only before eating.

  • Showers only in the morning before eating and cannot be longer than 10 minutes.

  • Completing schoolwork is acceptable if it does not interfere with eating.

Behavior Guidelines:

  • Caregivers should stay calm during meals and snacks and keep conversations low stress and positive.

  • Use encouraging statements, such as “I love you”, “I know you can do this”, “I believe in you”.

  • Do not engage in negotiating food and do not talk about calories or weight. Do not comment on food or appearance.

  • Encourage mechanical eating when needed.

  • Redirect unwanted behavior with brief, matter-of-fact statements, such as “I would like you to stop cutting your food so small”, “Let’s take bigger bites”.

  • Provide occasional reminders about timing.

  • If your child/teen refuses to eat or engages in eating disorder behaviors (such as exercise, vomiting, hiding food), consider the following possible consequences:

    • Remove physical activity. If your child is not eating, they need to conserve energy.

    • Remove sources of stress, such as their phone, computer, social visits, school, tv, social media.

    • Increase supervision by keeping the bathroom door open when they use it, sleeping in the same room, or removing their alone time.

  • Use positive reinforcement to increase wanted behaviors. This may include:

    • Praise

    • Motivating rewards such as visits with friends, screen time

    • Use cause and effect statements, such as “First _________, then _________.”

    • Make sure the size of the reward fits the size of the good behavior!

    • Natural and logical consequences help your child to make better decisions

    • Remember to work together with other caregivers. 

Coping strategies for caregivers to role model:

  • Take a break when angry or upset.

  • Name feelings out loud (“I feel ___”).

  • Communicate your needs (“I need _____”).

  • Self-soothe using your senses.

  • Ask for help when needed.

  • Take care of your own feelings and needs.

  • Apologize when you do something wrong.

  • Positive affirmations or mantras (“I can do this”).

  • Use “I” statements instead of “you” statements.

  • Schedule “ME” time.

  • Be consistent and reliable.

  • Practice gratitude.

  • Get fresh air and remember to breathe.

Follow up:

  • Follow up with these teams as recommended:

    • Medical provider

    • Behavioral health provider

    • Dietitian

  • Return to school requires approval from medical and other treatment provider(s).

 

Reviewed on 2/25/25 by Jonathon Pletcher, MD